This statement seems like it could be commented on easily, in one sentence, but it is actually the most difficult aspect to explain to people about metabolism. This statement is at the core of understanding what's happening to you, so you can treat it properly.
The exact mechanism of metabolic syndrome/diabetes still remains hotly debated. This is because these conditions affect many systems of the body. In other words, many system wide abnormalities must occur for the conditions to exist and progress. For this reason, there are many arguments over what occurs when and downstream or upstream from what. Some believe the cells are filled with sugar (low carb advocates) and others believe they are filled with fat (low fat/calorie restriction advocates). It depends on the narrative you are trying to push.
Do not get caught up in the pedantic ramblings of all of these blogs and pages that try to break down studies, they themselves don't fully understand. Most of them are just trying to push their own agendas.
The only thing you need to know is what will get you closer to reversing your condition and that is your blood glucose regulation because the only thing that tracks linearly with obesity and the eventual development of diabetes is your blood glucose regulation. Chronic disruptions in blood glucose homeostasis eventually deteriorate its proper regulation. Poor blood glucose regulation causes improper insulin release/expression, which further deteriorates blood glucose. This will cause an adaptation towards starvation which is when the body actively prevents any lowering of blood glucose as it deems it as hypoglycemia. Now your blood glucose, insulin and body fat set points are set high and the body will actively prevent any them from lowering.
So in essence, we can describe that cells refuse glucose entry in order to spare it to make more fat. Glucose turns into fat. This is why there is insulin resistance in tissues and organs but insulin super sensitivity at the fat mass. So it doesn't much matter what your cells are "filled with". The only thing that matters is that your fat mass is getting filled with more fat and the lever is your blood glucose regulation.
2. High triglycerides are meaningless. Only high blood glucose is a problem.
When the body converts glucose into fat, at an exponential rate, serum trigs rise. Trigs are the metric used to measure fat in the blood, just like your glucose meter measures glucose in the blood.
High trigs and high glucose are caused by the same thing - metabolic syndrome, which basically sets your blood glucose, insulin and body fat points to high.
People with high trigs are experiencing metabolic syndrome and their glucose might also be high, either after meals or while fasting as well. Just because trigs are fat, doesn't mean they are caused by dietary fat. They are actually caused by the conversion of glucose into fat through de novo lipogenesis in the liver.
Interestingly, there is a small segment of the population that is obese and/or has metabolic syndrome, but continue to exhibit low trigs. This is usually because their liver is absorbing all of the fat into itself, rather than dispersing a large amount into the bloodstream. So being obese, with low trigs can be the first signs of being at very high risk for future liver disease.
3. If your insulin levels are low, but you are still obese, you need to eliminate any foods that may still be effecting your insulin.
Many things effect insulin. This is why we mainly focus on insulin expression, not insulin levels, on this blog.
It is obvious that your insulin, regardless of its level, is not functioning as it should. It is building fat instead of anything else. This means you have not normalized your blood glucose regulation and your insulin is still being affected.
4. Do I have "sarcopenic" obesity?
All obesity is sarcopenic. Sarcopenic obesity simply means that the body is breaking down its lean muscle mass to create more glucose in order to convert it into even more body fat. Obesity eats at your muscle mass making you fatter by default.
5. "Low carb doctors" like for liver enzymes to be in the teens. If you are over, then you have to cut back further on carbohydrates.
This is why you have to be careful with "low carb doctors". There are no such things as "low carb doctors". You are either a doctor, with an MD, or you're not. I suggest that you go to a conventional, real doctor to get your liver enzymes assessed properly. Then you can apply a low carb treatment to address any issues depending on their cause.
If you are already zero carb, then it's obvious you are not generating liver fat from your diet. This means that eliminating carbs is not working. This is because your generating liver fat from the breakdown of your own lean muscle mass. In other words, the glucose is not coming from the outside, it's coming from the inside. This is mainly driven by adrenal over expression and being zero carbs might be triggering it further as it could be a stressor for the body.
I recommend you ditch the "zero carb diet" and go moderate low carb to see if it improves your liver enzymes. If it doesn't, then the problem is being caused by some abnormality within the liver itself. It could be a virus or alcohol consumption. You will have to work with your doctor in order to determine what's going on and address it. Even though fatty liver disease is most commonly caused by alcohol and/or fructose consumption, there are other conditions that can also cause disease in the liver.
6. Do you need to eat fat to become "fat adapted"?
No. This is just nonsense. If any people on earth are "fat adapted", it's the obese. The obese are adapted to get fatter.
The premise this is based on is that you become "fat adapted" by lowering the consumption of carbohydrates enough to where glucose is no longer displacing fat oxidation. Basically this is a state where there is very little blood glucose and glycogen stores to burn for energy, so the body burns fat instead. Therefore, there technically is no "adaptation", there is only "allowance".
Of course, that is only a premise. When you have metabolic syndrome, these systems do not work so efficiently. You need proper insulin and leptin expression for any of this to actually work.
Either way, you want to burn body fat, not just fat. So, dietary fat also has to be low enough so the body can do just that.
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